Inspection on 29/06/06 for Durham Avenue

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Durham Avenue 10/09/07

Durham Avenue 24/01/06

Durham Avenue 06/09/05

Durham Avenue 08/03/05

Durham Avenue 25/11/04

Durham Avenue 03/03/04

Similar services:

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Clover House

Parkside

Park Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 13 Durham Avenue 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD Lead Inspector Phil McConnell Unannounced Inspection 29th June 2006 09:30 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 13 Durham Avenue Address 13 Durham Avenue St Annes On Sea Lancashire FY8 2BD 01253 640880 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David Calwell Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Durham Avenue Care Home is currently registered to accommodate up to three adults who have a learning disability. The home is located in a quiet residential area of St Annes but within easy reach of the main shopping centre of the town, community facilities and resources. Communal areas of the home are domestic in character and each resident is accommodated in single bedroom accommodation. Service users access the local community and are an accepted part of it. The staff group ensure there is a homely and comfortable atmosphere in the home and that service users are enabled and empowered to maintain and maximise their independence. The present rate of charging (depending on individual needs) is between £639 and £1,299. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The assimilation of information, from questionnaires and comment cards from service users, relatives, GP’s and other professionals, including the provider since the last published report by the Commission for Social Care Inspection (CSCI) and an unannounced visit to the home, were all used to fully assess the key standards identified in the National Minimum Standards. The visit to home lasted approximately seven hours. The house manager was available during the visit to the home and there was also the opportunity to speak to all of the service users, (including two service users from their sister home 6 Lord Street) one staff member and have a short telephone conversation with the owner There was a good atmosphere in the home and it was observed by the way staff and service users spoke to each other that a good rapport existed between them. The service users’ files were examined and discussions took place with the staff on duty and with the service users. Policies, procedures and staff files were also examined and a full tour of the home was undertaken. What the service does well: There was a pleasant atmosphere in the home and it is apparent that the staff and service users have developed good and trusting relationships. Routines are flexible so that service users can with support and guidance choose the lifestyle of their choice. This is achieved with the provision of adequate staffing levels, enabling service users to pursue their chosen individual activities, whether it be supported employment, attending college or social activities within the community. During the visit staff spent time talking to and listening to those living at the home and previous inspections have also seen this high level of interaction. The staff team has not changed since the previous inspection and some of the feedback from staff members was “we are all very flexible, work well together and get on really well with each other”. The training provided by the organisation was seen to be of a good standard and one staff comment was, “They (management) are absolutely brilliant and any training you require, they are really good in providing it” 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 “Quality in this outcome area is – ‘Good’. This judgement has been made using available evidence including a visit to this service.” A thorough, detailed pre-admission process is in place; with sufficient information and guidance to enable a prospective service user to make an informed choice. EVIDENCE: There have not been any new admissions to the home since the last inspection. Policies and procedures were inspected and found to be up to date and satisfactory. The service users’ files were examined and their care plans contained relevant and up to date information in order to assist staff in providing the appropriate assessed level of care, to meet individuals’ needs. Part of the organisations ‘statement of purpose’ (a document which details the care and support a person would receive) includes, “We aim to offer care, compassion and support to all residents. We will encourage them to maintain their own individuality and to take a pride in themselves and their own achievement. The needs and aspirations of the residents are paramount. The home and staff are there to enable them to be met”. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 9 In observation, discussion with the service users, and feedback from service users’ questionnaires, it was apparent that the staff team are committed to ensuring that the above is put into practice. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. “Quality in this outcome area is – ‘Good’. This judgement has been made using available evidence including a visit to this service”. Service users are encouraged and supported to make appropriate decisions and take assessed risks in their lives, empowering them to be as independent as possible. EVIDENCE: Service users are as much as possible actively involved in decision making, taking into account their individual level of ability. This was observed by the interaction between the service users and staff, and the inspection of individuals care plans. Service users’ files also contained information regarding ‘registration to vote’, with voting cards and there was also evidence of service users having their own ‘last will and testament’, which further demonstrates that people are encouraged and supported to make important and valued decisions about their lives. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 11 It was observed that risk assessments are in place in order that service users are supported to live as independently as possible. Throughout the home there was evidence (photographs) of individuals participating in a variety of different leisure and recreational activities and in discussion with service users, there was a sense of achievement and excitement about the different activities that people are involved in. The questionnaires received from service users stated that they always make decisions about their daily activities, with one service user saying, “I go to college and make things, I go on the computer and go to the pictures” another person commented, about going on holiday to visit a relative and “I like going on planes”, further clarifying that people are empowered and enabled to make decisions about the activities and lifestyles they choose. There was information available regarding an independent advocacy service, if a service user is in need of an impartial representative to advocate for them, demonstrating that the provider is committed to ensuring that a service users’ choices, opinions and decisions are listened to and acted upon appropriately. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 16 and 17 “Quality in this outcome area is – ‘Good’. This judgement has been made using available evidence including a visit to this service” Service users are involved in meaningful and appropriate activities, giving them the motivation and stimulation to promote a sense of achievement and wellbeing. Service users are encouraged to keep contact with their relatives and friends, to help ensure that relationships are maintained. The food menus provide a balanced and wholesome diet, helping to promote a healthy eating plan for service users. EVIDENCE: All of the service users living at Durham Avenue are in need of support, when engaged in leisure or recreational activities. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 13 In discussion with service users, members of staff and from information gathered from files it was clear that service users have the opportunity to participate in varied and valued activities both in the local community and further a field. During the inspection two service users from the organisations other home were visiting and it was apparent that friendships exist between them all. The service users and the staff confirmed that there is a strong link between the two homes and the service users often participate in leisure and recreational activities together, one staff member commented, “most of the service users have been friends for a long time” and “of course there are times when there are disagreements, but that’s normal”. In discussion with service users and examining files, it was clearly identified that service users do have relationships with friends and contact with family members is encouraged and supported. There were lists in individuals’ files of birthdays and address’s of friends and relatives and it was also noted that people have regular contact by telephone. It was evident the staff team encourage service users to maintain and develop their relationships with family and friends. As already mentioned there was evidence that people have ‘wills’ and voting cards in their files, further demonstrating that service users are encouraged and empowered to be responsible and recognising that people have rights. It was observed that there was a good rapport between the staff on duty and the service users and it was evident that respect, privacy and dignity are demonstrated within the home. Service users are supported to prepare and cook their own meals and are actively involved in choosing menus, highlighting that people are enabled to be as independent as possible. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 “Quality in this outcome area is – ‘Good’. This judgement has been made using available evidence including a visit to this service” Service users are treated with respect and dignity in all aspects of personal care. The home works in partnership with other agencies to ensure that service users’ health needs are fully assessed and addressed. EVIDENCE: Service users’ files were well organised with concise individual care plans, covering: physical ability, mobility, medical history and pattern of living. These well kept files gave clear guidance for care staff on how to provide personal care to service users, thereby helping to ensure that service users’ assessed personal and health needs were being met. Staff have received training regarding respect, privacy and dignity, and this was positively demonstrated during the inspection. Staff members were observed speaking to service users in a polite, courteous and respectful manner. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 15 There were daily communication handover sheets, which were informative and up to date, in order to assist the carers in meeting the service users’ daily needs. Medication procedures and records were examined and found to be satisfactory, with staff being appropriately trained in the storage, administration and recording of medicines. It was observed that an error had occurred the previous day; one of the service users was given the wrong medication. (Morning medication instead of evening) The mistake had been rectified, with no adverse problems caused and it had been properly recorded in line with the medication policy and procedures. Some concerns had been identified from a previous advisory / pharmacy inspection and these issues have been appropriately addressed, including, keeping different record books, recording the receipt of medicines, an audit book and a book for recording the disposal of medicines. GP’s hold regular medication reviews for service users, which also helps to guarantee that correct medicines and dosages are administered to individuals, in order to safeguard, promote and maintain their health. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. “Quality in this outcome area is – ‘Good’. This judgement has been made using available evidence including a visit to the service”. Satisfactory policies and procedures are in place, helping to protect and safeguard service users. EVIDENCE: The policy and procedures were examined and found to be thorough and concise, with relevant addresses and telephone numbers for Social Services, CSCI (commission for social care inspection) and local ombudsman. There was a copy of the ‘No secrets’ document, which gives guidelines regarding the protection of vulnerable adults and in speaking to staff; there was a clear understanding of the importance about the protection of vulnerable adults. Service users’ files contained complaint cards, which were in an easy format, thereby helping service users who may have some reading difficulties to better understand. All staff have received ‘The Protection of Vulnerable Adults’ training which is supplied by an independent training organisation. (Ormerod Trust). All staff had signed to confirm that they had read the policy and procedures regarding ‘Concerns and Complaints’ and that they would adhere to them. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. “Quality in this outcome area is – ‘Poor’ This judgement has been made using available evidence including a visit to this service”. A number of issues need to be addressed, to ensure that people live and work in a safe and comfortable environment EVIDENCE: A tour of the home was carried out and it was generally clean and homely, with collages of photographs placed around the home, showing various activities, days out and holidays that service users have been involved in. However, there were a number of items that need addressing, the service users’ bedrooms are all in need of being redecorated, with one comment being “My bedroom will have new paper soon” and one service user said, “My room is too small”. The provider is aware of this and in discussion with the house manager, it was stated that the service user had been given the opportunity to move, but had declined at the moment of moving. The inspector commented that it would be good if this could be pursued with the person being motivated and encouraged to move to a larger bedroom, which would better suit the person’s needs. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 18 Some of the carpeting within the home needs attention, especially were there are missing carpet grips, this could cause a trip hazard. The decoration in the hall, stairs and landing is dark and dull and would benefit from being made lighter or the electric lighting changed to help create a brighter and fresher environment. The bathroom has been decorated since the last inspection, but there is a need to ensure that some kind of lock is fitted to both the bathroom and the toilet, in order for privacy to service users and to staff members. The kitchen area is in need of some attention, including: the flooring, which is uneven, cracked and badly fitted, the kitchen cupboards were unsightly and the worktops were unhygienic, with exposed edges and badly damaged joints. The window frames are badly in need of either being replaced, because they are rotten or painting. The backyard had a large hole in the concrete, which is a safety concern. Feedback was given after the inspection and all of these issues were raised with the house manager, who will inform the provider. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. “Quality in this outcome area is – ‘Good’. This judgement ahs been made using available evidence including a visit to the service” The staff are well trained and competent, giving the confidence that service users are adequately and appropriately supported. A thorough recruitment policy and procedures were in place, ensuring as far as possible the protection of service users. EVIDENCE: A thorough recruitment policy was in place with satisfactory procedures (reviewed January 2006), which took into account the need to protect service users. Staff files contained evidence that Criminal Record Bureau (CRB) checks had been carried out and staff are only employed on the satisfactory completion of these checks. This helps to ensure that service users are protected and safeguarded by having a robust recruitment selection process. A member of staff said, “ The service users were asked if they would like me to come and work with them?” highlighting that service users are consulted and involved in the recruitment process. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 20 Staff members have varied experience in working with people from different cultures and faiths. In discussion with staff, there was an understanding and awareness of peoples’ cultural and religious needs. Staff files also contained information with regards to the skills and training that staff have received. Most of the staff have already achieved the National Vocation Qualification (NVQ) at level 2 with planning in place for the remaining staff to obtain this training award. The training for staff was seen to be satisfactory and appropriate; in order to meet the service users’ assessed needs. Staff commented: “Any training you require, they (providers) are really good to provide it” and “They are absolutely brilliant with training”. Members of staff were observed interacting with service users and there was an obvious rapport between staff and service users. The staff were listening and interested, which gave an indication that the staff were committed to the people they supported and cared for. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. “Quality in this outcome area is – ‘Adequate’. This judgement has been made using available evidence including a visit to the service”. The home is well managed and organised, ensuring as much as possible that service users receive a good service. All health and safety checks are not sufficiently carried out, causing unnecessary risks to service users and to staff. EVIDENCE: The registered manager at Durham Avenue has many years of experience in the care and support of people with Learning Disabilities, with various relevant training courses having been completed. Since the last inspection the manager has registered to commence ‘The National Vocation Qualification’ at level 4 (NVQ). This will give him a recognised qualification in management, which was identified in the last inspection report (January 2006). 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 22 The organisation has completed ‘A Quality Development Plan’ for 2006/2007, which incorporates the objectives that were achieved for 2004/2005, including: A revised complaints procedure, with new service user questionnaires and it was reported that these questionnaires are being used successfully. The organisation has maintained the Investors in People Award, (a quality assurance monitoring organisation) demonstrating that there is a commitment from the organisation to have it’s quality of care assessed both internally and externally. All of the homes policies relating to health and safety were inspected and were found to be up to date, with review dates in place, helping to show that the health and safety of all who live and work at Durham Avenue is taken seriously. Inspection certificates, including; electrical inspection, gas inspection and employers liability insurance were available for examination and up to date, however, the electrical appliance testing certificate was out of date (identified in previous report). It is essential that all health and safety checks be carried out, to help ensure that service users and staff are protected and safeguarded with regards to health and safety matters. 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X X 2 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 13 (4) (c) Requirement All Health and Safety certificates (Electrical appliance testing) should be up to date and available for inspection. Certain areas of the building must be repaired and redecorated to ensure they remain of an acceptable standard. (Previous timescale of 30/4/06 not met) Timescale for action 31/08/06 2. YA24 23(2)(b) 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 13 Durham Avenue DS0000010073.V292473.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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